EAST TEXAS BORDER HEALTH CLINIC (GENESIS PRIMECARE) - NPI NUMBER 1700134996

Summary

Provider Name: EAST TEXAS BORDER HEALTH CLINIC (GENESIS PRIMECARE)

NPI Number: 1700134996

Clasification: General Practice (208D00000X)

Address:
502 E RUSK ST
MARSHALL, TX
ZIP 75670

Phone Number: (903) 927-3782



Detailed Information

EAST TEXAS BORDER HEALTH CLINIC is a general practitioner in Marshall, TX. The assigned NPI number for this provider is 1700134996 and is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Genesis Primecare.

The provider's business address is:

502 E RUSK ST
MARSHALL, TX
ZIP 75670-408
Phone: (903) 927-3782
Fax: (903) 927-1764

The provider's authorized official is David L Hartman .
The authorized official title is Ceo and has the following contact phone number (903) 927-3782.

The enumeration date for this NPI number is 8/21/2012 and was last updated on 8/21/2012.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1245583848 DR. BOB J HERRIN
General Practice





Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 208D00000X General Practice Yes

NPI Record

No. Field Name Field Value
1 NPI 1700134996
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name EAST TEXAS BORDER HEALTH CLINIC
5 Provider Other Organization Name GENESIS PRIMECARE
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 502 E RUSK ST
8 Provider Business Practice Location Address City Name MARSHALL
9 Provider Business Practice Location Address State Name TX
10 Provider Business Practice Location Address Postal Code 756703408
11 Provider Business Practice Location Address Country Code If outside U S US
12 Provider Business Practice Location Address Telephone Number 9039273782
13 Provider Business Practice Location Address Fax Number 9039271764
14 Provider Enumeration Date 8/21/2012
15 Last Update Date 8/21/2012
16 Authorized Official Last Name HARTMAN
17 Authorized Official First Name DAVID
18 Authorized Official Middle Name L
19 Authorized Official Title or Position CEO
20 Authorized Official Telephone Number 9039273782
21 Healthcare Provider Taxonomy Code 1 208D00000X
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Is Organization Subpart N
24 Authorized Official Name Suffix Text JR.
25 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP

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This page was last updated on: 11/14/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.